RESUMO
BACKGROUND: Botulinum toxin type A has been used for treating the hypertrophy of the masseter muscles and its cosmetic effects. Ultrasound is increasingly used in dermatology, along with the guidance of mini-invasive procedures. AIMS: To evaluate the role of ultrasound for guiding the application of Botulinum A toxin in patients with cosmetic alterations due to bruxism, correlate the clinical landmarks with the ultrasound findings, and study the effect on the symptoms, cosmetics, and quality of life. PATIENTS/METHODS: Twenty individuals with bruxism and cosmetic alterations underwent an ultrasound-guided injection of Botulinum toxin type A in each masseter muscle. Clinical and ultrasound marking of the procedure was compared. Clinical and sonographic evaluation was performed at the time of injection and 3 months later. Ten normal individuals underwent ultrasound of the masseter muscles as a control group. RESULTS: Up to 65% of individuals showed anatomical variants of the salivary glands. The method for clinically marking the skin showed a frequently erroneous location of the anterior point (up to 40% of cases) that was proven by ultrasound to be out of the muscle. In 20% of cases, ultrasound showed that the needle should be longer to enter the muscle. After injection, most of the patients demonstrated a decrease of the symptoms and cosmetic and quality of life improvements. CONCLUSIONS: Ultrasound can be a potent tool for guiding the injection of Botulinum toxin into the masseter muscles. It may contribute to a more personalized procedure, better cosmetic results, and help to avoid potential complications.
Assuntos
Pontos de Referência Anatômicos , Toxinas Botulínicas Tipo A/administração & dosagem , Bruxismo/tratamento farmacológico , Músculo Masseter/patologia , Fármacos Neuromusculares/administração & dosagem , Ultrassonografia Doppler , Adulto , Bruxismo/complicações , Estudos de Casos e Controles , Estética , Face/patologia , Feminino , Humanos , Hipertrofia/complicações , Injeções Intramusculares , Masculino , Músculo Masseter/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Ultrassonografia de IntervençãoRESUMO
La dermatosis IgA lineal de la infancia es una infrecuente enfermedad vesiculoampollar adquirida de etiología autoinmune, caracterizada por los depósitos de IgA en una banda lineal en la membrana basal dermoepidérmica, que se observan con la técnica de inmunofluorescencia directa. Las lesiones características son vesículas y ampollas serosas tensas, por lo general, agrupadas dando un aspecto de "conjunto de joyas". El diagnóstico diferencial debe establecerse principalmente con otras dermatosis autoinmunes, como la dermatitis herpetiforme y el penfigoide buloso. El tratamiento de primera línea es la dapsona, con excelente respuesta a corto plazo. La enfermedad es benigna y tiende a cursar en brotes hasta su resolución espontánea. Presentamos el caso de una niña de 5 años que consulta por lesiones ampollares; se diagnosticó una dermatosis IgA lineal de la infancia, con excelente respuesta al tratamiento con dapsona en menos de 2 semanas.
Linear IgA bullous dermatosis is a rare acquired autoinmune vesiculobullous disease characterized by linear IgA deposit on the dermo-epidermal basement membrane observed with direct inmunofluorescence. The characteristic lesions are vesicles and tense serous bullae, which most often are grouped giving a "cluster of jewels" appearance. Differential diagnosis must be established with other autoimmune dermatosis, such as dermatitis herpetiformis and bullous pemphigoid. Dapsone is the first line therapy, with excellent response in a short period. This is a benign disease that tends to wax and wane in severity until it disappears spontaneously. We report the case of a 5-year-old girl presenting with bullous lesions, being diagnosed a linear IgA bullous dermatosis, with excellent response to dapsone in less than 2 weeks.
Assuntos
Pré-Escolar , Feminino , Humanos , Dermatose Linear Bolhosa por IgA , Dermatose Linear Bolhosa por IgA/diagnósticoRESUMO
La dermatosis IgA lineal de la infancia es una infrecuente enfermedad vesiculoampollar adquirida de etiología autoinmune, caracterizada por los depósitos de IgA en una banda lineal en la membrana basal dermoepidérmica, que se observan con la técnica de inmunofluorescencia directa. Las lesiones características son vesículas y ampollas serosas tensas, por lo general, agrupadas dando un aspecto de "conjunto de joyas". El diagnóstico diferencial debe establecerse principalmente con otras dermatosis autoinmunes, como la dermatitis herpetiforme y el penfigoide buloso. El tratamiento de primera línea es la dapsona, con excelente respuesta a corto plazo. La enfermedad es benigna y tiende a cursar en brotes hasta su resolución espontánea. Presentamos el caso de una niña de 5 años que consulta por lesiones ampollares; se diagnosticó una dermatosis IgA lineal de la infancia, con excelente respuesta al tratamiento con dapsona en menos de 2 semanas.(AU)
Linear IgA bullous dermatosis is a rare acquired autoinmune vesiculobullous disease characterized by linear IgA deposit on the dermo-epidermal basement membrane observed with direct inmunofluorescence. The characteristic lesions are vesicles and tense serous bullae, which most often are grouped giving a "cluster of jewels" appearance. Differential diagnosis must be established with other autoimmune dermatosis, such as dermatitis herpetiformis and bullous pemphigoid. Dapsone is the first line therapy, with excellent response in a short period. This is a benign disease that tends to wax and wane in severity until it disappears spontaneously. We report the case of a 5-year-old girl presenting with bullous lesions, being diagnosed a linear IgA bullous dermatosis, with excellent response to dapsone in less than 2 weeks.(AU)
RESUMO
Linear IgA bullous dermatosis is a rare acquired autoinmune vesiculobullous disease characterized by linear IgA deposit on the dermo-epidermal basement membrane observed with direct inmunofluorescence. The characteristic lesions are vesicles and tense serous bullae, which most often are grouped giving a "cluster of jewels" appearance. Differential diagnosis must be established with other autoimmune dermatosis, such as dermatitis herpetiformis and bullous pemphigoid. Dapsone is the first line therapy, with excellent response in a short period. This is a benign disease that tends to wax and wane in severity until it disappears spontaneously. We report the case of a 5-year-old girl presenting with bullous lesions, being diagnosed a linear IgA bullous dermatosis, with excellent response to dapsone in less than 2 weeks.
Assuntos
Dermatose Linear Bolhosa por IgA , Pré-Escolar , Feminino , Humanos , Dermatose Linear Bolhosa por IgA/diagnósticoRESUMO
Linear IgA bullous dermatosis is a rare acquired autoinmune vesiculobullous disease characterized by linear IgA deposit on the dermo-epidermal basement membrane observed with direct inmunofluorescence. The characteristic lesions are vesicles and tense serous bullae, which most often are grouped giving a "cluster of jewels" appearance. Differential diagnosis must be established with other autoimmune dermatosis, such as dermatitis herpetiformis and bullous pemphigoid. Dapsone is the first line therapy, with excellent response in a short period. This is a benign disease that tends to wax and wane in severity until it disappears spontaneously. We report the case of a 5-year-old girl presenting with bullous lesions, being diagnosed a linear IgA bullous dermatosis, with excellent response to dapsone in less than 2 weeks.